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Medical Staff Credentialing Coordinator

Company: Northwest Community Healthcare
Location: Arlington Heights
Posted on: June 8, 2021

Job Description:

Shift: Full time, Days

Reporting to the Director of Medical Staff Services the Credentialing Auditor will provide operational oversight for the quality and audit function of all practitioner's credentialing and recredentialing files to ensure accuracy and completeness before review by Medical Staff Leadership. This position will act as the liaison between the Director and Medical Staff Credentialing Coordinators. This quality-oriented product will provide rapid turn-around for both the practitioner and the facility in a cost-efficient manner while maintaining compliance with appropriate state and federal laws, regulatory agencies, payers and medical staff bylaws/rules/regulations and policies.

  1. Audits 100% of credentialing and re-credentialing files submitted by the Credentialing Coordinators for accuracy and completeness. This includes the auditing of data entry and scanning in the Credentialing Database as well as documentation submitted.

  2. Tracks and trends any errors identified as well as monthly turnaround times.

  3. Returns audited files for corrections to the relevant Credentialing Coordinator, for the purposes of data correction and education.

  4. Prepares credentialing and re-credentialing files for file review with Medical Staff Leaders and meets one-on-one with Medical Staff Leaders, if requested.

  5. Prepares Credentialing Reports for all NCH entities to include on their Committee Meeting Agendas and is manages and participates in Credentials Committee meetings.

  6. Develop, implement and maintain Credentialing audit tools annually to ensure compliance with all current Joint Commission, NCQA, AAAHC, State and Federal requirements.

  7. Works closely with Director to meet the educational needs of the Credentialing Coordinators and provides in-service/orientation/education as needed.

  8. Manages annual payer delegation audits in conjunction with Director.

  9. Assists in coordination of office workflow operations

  10. Maintains working knowledge of credentialing and recredentialing processes and assists as necessary.

  11. Additional office duties, as needed.

  12. The level of knowledge normally acquired through completion of a Bachelor's Degree is required.

  13. Certification by the National Association Medical Staff Services as either a CPCS or CPMSM or become certified within 3 years of employment.

  14. A minimum of at least 5 years of experience in a central verification office, hospital or managed care setting.

  15. Strong knowledge of the acute care/hospital credentialing process, including initial appointment, privilege delineation and reappointment.

  16. Knowledge of payer delegation process.

  17. Knowledge and experience in medical/legal issues and laws and regulatory requirements (TJC, NCQA, AAAHC, CMS Conditions of Participation)

  18. Strong computer skills including MS Word, MS Excel and knowledge of MSOW software credentialing system.

  19. Strong organizational skills with required attention to detail; Ability to solve problems and resolve conflicts.

  20. Excellent oral and written communication skills with staff, physicians and executives.

  21. Excellent interpersonal skills and ability to work effectively and efficiently with others

  22. Ability to work independently

  23. Ability to maintain confidential information and exhibit a professional appearance and demeanor; ability to travel between the multiple NCH entities, if needed.

PHYSICAL REQUIREMENTS:

  1. Requires very little physical effort. Required to walk or stand for prolonged periods. May require occasional lifting or moving lightweight material, or rarely lifting or moving average weight material.

  2. The flow of work and character of duties involves normal mental and visual attention much or all of the time.

WORKING CONDITIONS:

  1. Typical office working conditions. Absence of disagreeable elements. Probability of injury is small.

Keywords: Northwest Community Healthcare, Arlington Heights , Medical Staff Credentialing Coordinator, Other , Arlington Heights, Illinois

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